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Original Research: Diffuse Lung Disease |

Effect of Fasting on the Size of Lymphangioleiomyomas in Patients With LymphangioleiomyomatosisFasting and Lymphangioleiomyomas

Angelo M. Taveira-DaSilva, MD, PhD; Amanda M. Jones, CRNP; Patricia Julien-Williams, CRNP; Thomas Shawker, MD; Connie G. Glasgow, BS; Mario Stylianou, PhD; Joel Moss, MD, PhD
Author and Funding Information

From the Cardiovascular and Pulmonary Branch (Drs Taveira-DaSilva and Moss and Mss Jones, Julien-Williams, and Glasgow) and Office of Biostatistics Research (Dr Stylianou), National Heart, Lung, and Blood Institute; and the Radiology and Imaging Sciences Department (Dr Shawker), National Institutes of Health, Bethesda, MD.

CORRESPONDENCE TO: Angelo M. Taveira-DaSilva, MD, PhD, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, Room 6D03, MSC 1590, Bethesda, MD 20892-1590; e-mail: dasilvaa@nhlbi.nih.gov


FUNDING/SUPPORT: This study was supported by the Intramural Research Program, National Institutes of Health, National Heart, Lung, and Blood Institute [Grant NHLBI 08-H-0016].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):1027-1033. doi:10.1378/chest.15-0456
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BACKGROUND:  Lymphangioleiomyomas occur in 38% of patients with sporadic lymphangioleiomyomatosis (LAM) and may cause pain and increased abdominal girth, mimicking the presence of a malignancy. Lymphatic involvement in LAM is closely associated with elevated serum levels of vascular endothelium growth factor-D (VEGF-D). Because lymphangioleiomyomas undergo diurnal variation in volume, we hypothesized that daytime ingestion of food, by increasing chyle formation and lymphatic flow, is the cause of an increase in lymphangioleiomyoma volume.

METHODS:  Subjects had abdominopelvic sonograms and blood drawn for measurement of serum VEGF-D levels under nonfasting (day 1) and fasting (day 2) conditions. The size of the lymphangioleiomyomas was determined by a radiologist who was blinded to the subjects’ status. The Wilcoxon signed rank test was used to determine whether the nonfasting tumor size was different from the fasting tumor size.

RESULTS:  Thirty-five women were studied (aged 45.2 ± 8.5 years; FEV1, 82% ± 25%; diffusing capacity of the lung for carbon monoxide, 64% ± 25% predicted). Images suitable for volume measurements were obtained in 30 subjects. Fasting decreased the tumor size by 20.7 ± 39.3 cm3 (24% ± 40%, P < .001). Fasting VEGF-D levels (10,650 ± 900 pg/mL) were not significantly different from nonfasting values (12,100 ± 800 pg/mL, P = .56).

CONCLUSIONS:  Lymphangioleiomyoma volume decreased during the fasting state. Conversely, a combination of food intake and decreased chyle flow through lymphatics partially obstructed by LAM cells may account for increases in lymphangioleiomyoma size. Imaging studies performed under fasting conditions may help in determining whether an abdominal tumor is a result of LAM or malignancy.

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